U.S. pill abuse may not make cartels completely irrelevant

The drugs of choice for an increasing number of Americans are prescription painkillers. Nowhere is the problem more apparent than Houston, where the renowned medical center area has become “a national hotspot for prescription drug abuse,” according to a recent story in the Houston Chronicle. The paper reported in November that a Drug Enforcement Administration operation dubbed “King of the Pill” shut down “pill mills” in raids that were the culmination of an eight-month investigation involving 14 state and local agencies. As policymakers grapple with how to address this growing problem — including a quiet reassessment of U.S. policies that focus on keeping illegal drugs out of the country — drug policy experts at the Baker Institute ask: What does rising prescription drug abuse mean for the “war on drugs”? Nathan Jones, the institute’s Alfred C. Glassell III Postdoctoral Fellow in Drug Policy, wraps up this installment of Baker Institute Viewpoints with a look at the impact of prescription pill abuse on Mexican drug cartels.

The federal government has identified prescription drug abuse in the United States as a significant portion of the U.S. drug problem. As director of the Office of National Drug Control Policy, R. Gil Kerlikowske described at a Center for Strategic and International Studies (CSIS) event, “prescription drugs, not coming across any border, take more lives than cocaine and heroin each year combined. And it is a bit of an unrecognized problem.”

This has important implications for a “drug war” that has hitherto involved a supply-side strategy, which focused on preventing the illicit importation of narcotics into the United States from foreign countries in particular, Latin America. Because prescription drug abuse is a largely domestic problem, one might think that Mexican drug cartels, often identified as a national security threat, seem less relevant. This trend begs an important question:

What will the rise in prescription drug abuse mean for “the drug war” as we know it?

Unfortunately, we should not write off Mexican drug cartels as an irrelevant actor in this market. Just as Mexican cartel cells have grown marijuana in U.S. national parks in an attempt to undercut medical and U.S. cultivated marijuana domestically, there are conceivable positions for Mexican drug cartels to enter the U.S. pill market.

The meth story

The methamphetamine pattern may be a useful analogy. In the 1990s and 2000s, U.S. state legislatures passed a series of control laws to tighten the supply of pseudoephedrine, an over-the-counter decongestant, which could be used to make methamphetamine. Individuals referred to as “smurfs” purchased small quantities of pseudoephedrine at many locations and sold them to “cooks” to convert into methamphetamine. When these controls became sufficiently tight—individuals had to show ID and were limited in how much pseudoephedrine they could purchase—methamphetamine production in Mexico skyrocketed. The U.S. meth market is now supplied by Mexican cartels that, in turn, purchased chemical precursors from India and China. A similar pattern could emerge in the prescription drug market, where Mexican cartels buy or produce prescription pills and transport them to the United States to satisfy the U.S. market utilizing existing distribution networks.

Cartel resilience

Mexican cartels will also continue to sell other drugs that are prohibited in the U.S. market including marijuana, cocaine, meth, ecstasy and heroin. Further, some cartels particularly, Los Zetas, make significant profits from extortion, kidnapping and human trafficking. Thus, they will not be going out of business even if prescription drug abuse is rising and states like Colorado and Washington are in the process of legalizing marijuana. Legalization does have the salubrious effect of denying organized crime significant profits, which, when combined with increased state capacity in Mexico, hastens the moment organized crime will be a more manageable problem.

Survey results on prescription drug abuse using pain relievers as a proxy

Counter-intuitively, the 2011 National Survey on Drug Use and Health indicated a statistically significant decline in people who had abused prescription drugs in the month prior to the survey. However, prescription drug abuse is still the second-most common form of drug abuse after marijuana.

The majority (54.2 percent) of those who abused prescription drugs got them “free from a friend or relative.” This would suggest education about the dangers of prescription drug abuse and programs to reclaim unused medications would be the most effective strategies for reducing prescription drug abuse.

According to the National Drug Abuse Survey 2011 results, only 1.9 percent of those surveyed who abused prescription drugs go obtained the drugs from “more than one doctor,” suggesting that “doctor shopping” is a limited part of the problem. Only 3.9 percent of those who abused prescription pain relievers got them from a drug dealer or stranger. If the aforementioned medication reclamation and education programs are successful, buying prescription medications from drug dealers will likely increase as an overall percentage of pain reliever abuse, allowing an opening for established organized crime groups to enter the market as wholesalers.

However, predictions about drug abuse trends are always difficult and may be complicated by the fact that Colorado and Washington have legalized marijuana for recreational use. With marijuana now recreationally legal in some states, it is possible that it will serve as an alternative to prescription drug abuse. As a softer drug, the health consequences of marijuana use may lesser than the abuse of many prescription drugs.

While I have painted a picture of the potential entry of Mexican organized crime in the prescription pill market, it remains unlikely in the near future. The more likely scenario is that this market will be supplied almost entirely domestically and “suppliers” will likely continue to be family and friends. Given the nature of prescription drug abuse, it is best addressed where it often begins, within the health system.